Coming soon · Book Profile
Who Will Care for Us
As America's aging population drives an explosive rise in demand for long-term care, this book argues that transforming the disrespected, low-wage direct care workforce by expanding their roles is both feasible and essential to better care, lower costs, and reduced inequality.
A profile of this book is on the way.
What it’s about
Paul Osterman's Who Will Care for Us? confronts a looming national crisis: the number of elderly and disabled adults needing daily assistance will nearly double in twenty-five years, yet the direct care workers—home care aides and certified nursing assistants—who do the day-to-day caregiving are poorly paid, poorly trained, disrespected, and confined to a narrow scope of practice. Drawing on nationally representative surveys, administrative data, and nearly 120 interviews across the long-term care system, Osterman documents who these workers are, how the fragmented financing and regulatory system constrains them, and why expanding their role would simultaneously improve care quality, attract the workforce we need, and save the health care system money by reducing emergency room visits, hospitalizations, and nursing home stays. Situating direct care within the larger challenge of America's low-wage economy, the book offers an industry-specific model for making good jobs out of bad ones—aligning the interests of consumers, workers, and payers—and lays out the demographic, financial, and political forces that could finally move a stagnant system toward reform.
The through-line
- Who it’s for
- A policymaker, advocate, provider, or engaged citizen who wants a humane and effective long-term care system and a way to make good jobs out of bad ones.
- The problem
- A rapidly aging population will double the demand for long-term care while the workforce that delivers it is poorly paid, poorly trained, disrespected, and shrinking relative to need. They feel overwhelmed by a bafflingly complex, fragmented system and anxious that no one will be available to care for their loved ones or themselves.
- The plan
- Understand the full long-term care system and the workforce embedded within it.
- Recognize and gather evidence that direct care workers can perform effectively in expanded roles.
- Establish training and scope-of-practice reforms that let workers do more.
- Use financial incentives, managed care integration, and regulatory levers to reward better care delivery.
- Build a political coalition of consumers and organized workers to demand reform.
- The payoff
- Elderly and disabled people receive higher-quality, continuous care that lets them stay in their homes and communities. · Direct care workers earn decent wages, receive respect, and have career paths within health care. · The health care system saves money by reducing avoidable emergency room visits, hospitalizations, and nursing home stays.
See our guide
Related profiles we’ve built
- Caring on the Clock →
- Authentic Happiness →
- Character Strengths and Virtues: A Handbook and Classification →
- Character Strengths Interventions: A Field Guide for Practitioners →
- Coaching for Leadership - The Practice of Leadership Coaching from the Worlds Greatest Coaches (J-B US non-Franchise… →
- 50 Top Tools for Coaching A Complete Toolkit for Developing and Empowering People →
- Coaching for Performance Whitmore →
- Co Active Coaching Kimsey House →
Additional reading
- The Everyday World as Problematic: A Feminist Sociology · Dorothy E. Smith
The author explicitly identifies Smith's work as the primary methodological and theoretical foundation for his study, particularly its focus on the disjuncture between lived experience and administrative texts.
- Living and Dying at Murray Manor · Jaber F. Gubrium
Cited by the author as one of the few existing ethnographic studies of nursing home life that provided a foundation for his own work.
- Ordered to Care: The Dilemma of American Nursing, 1850-1945 · Susan M. Reverby
This book provides historical context for the professional roles and status conflicts in nursing, which helps explain the position of the nursing assistants in the story.
- Manufacturing Consent: Changes in the Labor Process under Monopoly Capitalism · Michael Burawoy
Cited as an influential participant-observation study that, like 'Making Gray Gold,' connects the daily experiences of workers on the shop floor to the broader political economy of capitalism.
- Care and Equality: Inventing a New Family Politics · Mona Harrington
The book quotes Harrington in the first chapter to establish the contemporary "care crisis" and the failure to replace the care once provided by stay-at-home women, setting the stage for the author's own analysis.
- Ancient Law · Henry Maine
The author references Maine's classic argument about the societal shift from status to contract to frame her own argument that status obligations (based on gender and race) have persisted in both family and market relations concerning care.
- The Time Bind: When Work Becomes Home and Home Becomes Work · Arlie Russell Hochschild
Cited to describe the 'time bind' and 'stretch out' experienced by middle-class families, illustrating that the care crisis is no longer confined to the poor and has become a widespread societal problem.
- The Managed Heart: Commercialization of Human Feeling · Arlie Russell Hochschild
This book is foundational to the concept of 'emotional labor,' a key analytical tool used in many chapters to understand the psychological and relational demands of care work.
- Caring for America: Home Health Workers in the Shadow of the Welfare State · Eileen Boris and Jennifer Klein
Provides a deep historical and policy context for home care work, a major occupation covered in the book, particularly regarding its exclusion from labor law and recent organizing efforts.
- Making Gray Gold: Narratives of Nursing Home Care · Timothy Diamond
A classic ethnographic study that reveals the day-to-day realities, constraints, and relational aspects of work for nursing assistants, a key group of workers analyzed throughout this volume.